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Froehner M. Re: Marc-Oliver Grimm, Mototsuga Oya, Toni K. Choueiri, et al. Impact of Prior Cytoreductive Nephrectomy on Efficacy in Patients with Synchronous Metastatic Renal Cell Carcinoma Treated with Avelumab plus Axitinib or Sunitinib: Post Hoc Analysis from the JAVELIN Renal 101 Phase 3 Trial. Eur Urol 2024;85:8-12. Eur Urol 2024:S0302-2838(24)02250-4. [PMID: 38570248 DOI: 10.1016/j.eururo.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 04/05/2024]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
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Froehner M, Görner M, Merkle L, Kopka K, Zöphel K. 18Fluorine Prostate-specific Membrane Antigen 1007 Positron Emission Tomography for High-risk Prostate Cancer. Urology 2024:S0090-4295(24)00131-6. [PMID: 38423393 DOI: 10.1016/j.urology.2024.02.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 01/30/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Matthias Görner
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Lennart Merkle
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Klaus Kopka
- Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf (HZDR), Dresden, Germany; Faculty of Chemistry and Food Chemistry, School of Science, Technical University Dresden, Dresden, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
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Froehner M, Schroeder HE, Belz H, Toma M. Metastatic Kidney Cancer? Urology 2023; 181:e195-e197. [PMID: 37690545 DOI: 10.1016/j.urology.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | | | - Hanjo Belz
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Marieta Toma
- Department of Pathology, University Hospital Bonn, Bonn, Germany
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Wegener D, Aebersold DM, Grimm MO, Hammerer P, Froehner M, Graefen M, Boehmer D, Zips D, Wiegel T. Postoperative Radiotherapy of Prostate Cancer: Adjuvant versus Early Salvage. Biomedicines 2022; 10:biomedicines10092256. [PMID: 36140357 PMCID: PMC9496034 DOI: 10.3390/biomedicines10092256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/05/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Results of three randomized clinical trials (RCTs) comparing adjuvant radiotherapy (ART) and early salvage radiotherapy (eSRT) of prostate carcinoma and a subsequent meta-analysis of the individual patient data from these RCTs were recently published. The results suggest that early eSRT is as effective and potentially less toxic than ART. Therefore, eSRT should be considered the standard of care. However, due to limitations in the RCTs, ART remains a valid treatment option in patients with the combination of high-risk features such as Gleason Score (GS) 8–10, positive surgical margins (R1) and pathological T-stage 3 or 4 (pT3/4). This article provides a critical appraisal of the RCTs and the rationale for recommendations adopted in the current national guidelines regarding patients with high-risk features after radical prostatectomy (RP): ART should be offered in case of pT3/pT4 and R1 and Gleason Score 8–10; ART can be offered in case of pT3/pT4 and R0 and Gleason Score 8–10 as well as in case of multifocal R1 (including pT2) and Gleason Score 8–10. In any case, the alternative treatment option of eSRT in case of rising PSA should be discussed with the patient.
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Affiliation(s)
- Daniel Wegener
- Department of Radiation Oncology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- Correspondence: ; Tel.: +49-070-7129-86143
| | - Daniel M. Aebersold
- Department of Radiation Oncology, Inselspital Bern University Hospital, University of Bern, 3012 Bern, Switzerland
| | - Marc-Oliver Grimm
- Department of Urology, Jena University Hospital, 07743 Jena, Germany
| | - Peter Hammerer
- Department of Urology, University Hospital Braunschweig, 38106 Braunschweig, Germany
| | - Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, 09130 Chemnitz, Germany
| | - Markus Graefen
- Martini Clinic, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Dirk Boehmer
- Department of Radiation Oncology, Charité University Medicine Berlin, 10117 Berlin, Germany
| | - Daniel Zips
- Department of Radiation Oncology, University Hospital Tuebingen, 72076 Tuebingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, German Cancer Research Center (DKFZ), 69120 Heidelberg, Germany
| | - Thomas Wiegel
- Department of Radiation Oncology, University Hospital Ulm, 89081 Ulm, Germany
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Siltari A, Lönnerbro R, Pang K, Shiranov K, Asiimwe A, Evans-Axelsson S, Franks B, Kiran A, Murtola TJ, Schalken J, Steinbeisser C, Bjartell A, Auvinen A, Smith E, N'Dow J, Plass K, Ribal M, Mottet N, Moris L, Lardas M, Van den Broeck T, Willemse PP, Gandaglia G, Campi R, Greco I, Gacci M, Serni S, Briganti A, Crosti D, Meoni M, Garzonio R, Bangma R, Roobol M, Remmers S, Tilki D, Visakorpi T, Talala K, Tammela T, van Hemelrijck M, Bayer K, Lejeune S, Taxiarchopoulou G, van Diggelen F, Senthilkumar K, Schutte S, Byrne S, Fialho L, Cardone A, Gono P, De Vetter M, Ceke K, De Meulder B, Auffray C, Balaur IA, Taibi N, Power S, Kermani NZ, van Bochove K, Cavelaars M, Moinat M, Voss E, Bernini C, Horgan D, Fullwood L, Holtorf M, Lancet D, Bernstein G, Omar I, MacLennan S, Maclennan S, Healey J, Huber J, Wirth M, Froehner M, Brenner B, Borkowetz A, Thomas C, Horn F, Reiche K, Kreux M, Josefsson A, Tandefekt DG, Hugosson J, Huisman H, Hofmacher T, Lindgren P, Andersson E, Fridhammar A, Vizcaya D, Verholen F, Zong J, Butler-Ransohoff JE, Williamson T, Chandrawansa K, Dlamini D, waldeck R, Molnar M, Bruno A, Herrera R, Jiang S, Nevedomskaya E, Fatoba S, Constantinovici N, Maass M, Torremante P, Voss M, Devecseri Z, Cuperus G, Abott T, Dau C, Papineni K, Wang-Silvanto J, Hass S, Snijder R, Doye V, Wang X, Garnham A, Lambrecht M, Wolfinger R, Rogiers S, Servan A, Lefresne F, Caseriego J, Samir M, Lawson J, Pacoe K, Robinson P, Jaton B, Bakkard D, Turunen H, Kilkku O, Pohjanjousi P, Voima O, Nevalaita L, Reich C, Araujo S, Longden-Chapman E, Burke D, Agapow P, Derkits S, Licour M, McCrea C, Payne S, Yong A, Thompson L, Lujan F, Bussmann M, Köhler I. How well do polygenic risk scores identify men at high risk for prostate cancer? Systematic review and meta-analysis. Clin Genitourin Cancer 2022; 21:316.e1-316.e11. [PMID: 36243664 DOI: 10.1016/j.clgc.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/01/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Genome-wide association studies have revealed over 200 genetic susceptibility loci for prostate cancer (PCa). By combining them, polygenic risk scores (PRS) can be generated to predict risk of PCa. We summarize the published evidence and conduct meta-analyses of PRS as a predictor of PCa risk in Caucasian men. PATIENTS AND METHODS Data were extracted from 59 studies, with 16 studies including 17 separate analyses used in the main meta-analysis with a total of 20,786 cases and 69,106 controls identified through a systematic search of ten databases. Random effects meta-analysis was used to obtain pooled estimates of area under the receiver-operating characteristic curve (AUC). Meta-regression was used to assess the impact of number of single-nucleotide polymorphisms (SNPs) incorporated in PRS on AUC. Heterogeneity is expressed as I2 scores. Publication bias was evaluated using funnel plots and Egger tests. RESULTS The ability of PRS to identify men with PCa was modest (pooled AUC 0.63, 95% CI 0.62-0.64) with moderate consistency (I2 64%). Combining PRS with clinical variables increased the pooled AUC to 0.74 (0.68-0.81). Meta-regression showed only negligible increase in AUC for adding incremental SNPs. Despite moderate heterogeneity, publication bias was not evident. CONCLUSION Typically, PRS accuracy is comparable to PSA or family history with a pooled AUC value 0.63 indicating mediocre performance for PRS alone.
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Froehner M, Coressel Y, Koch R, Borkowetz A, Thomas C, Wirth MP, Hölscher T. Acceptance and efficacy of recommended adjuvant radiotherapy in patients with positive lymph nodes at radical prostatectomy: a preference-based study. World J Urol 2022; 40:1463-1468. [PMID: 35303155 DOI: 10.1007/s00345-022-03984-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/03/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To investigate acceptance and efficacy of recommended adjuvant radiotherapy in patients with positive lymph nodes at radical prostatectomy. METHODS Among 495 patients with positive lymph nodes who consecutively underwent radical prostatectomy between 2007 and 2017, we investigated 347 patients who were recommended to undergo adjuvant radiotherapy by a multidisciplinary post-therapeutic tumor board and in whom information whether such treatment was eventually given was available. The median follow-up for censored patients was 5.4 years. Univariate analyses were performed using Kaplan-Meier curves, Mantel-Haenszel hazard ratios and log rank tests. Proportional hazard models for competing risks were used for multivariable analyses. RESULTS Adjuvant radiotherapy was independently associated with lower overall mortality and in high-risk patients (Gleason score 8-10 or three or more involved lymph nodes) also with lower prostate cancer-specific mortality. In patients with a Gleason score of 8-10 or three or more involved lymph nodes, the hazard ratio for adjuvant radiotherapy was 0.455 (95% confidence interval 0.257-0.806, p = 0.0069) for overall and 0.426 (95% confidence interval 0.201-0.902, p = 0.0259) for prostate cancer-specific mortality. Among patients receiving adjuvant radiotherapy, there was a trend to lower mortality when such treatment was combined with adjuvant androgen deprivation. CONCLUSION Adjuvant radiotherapy decreased mortality in patients with positive lymph nodes at radical prostatectomy with further disease factors but not in patients with low-risk disease. Simultaneous androgen deprivation might increase efficacy. Multidisciplinary recommendations may possibly increase the use of adjuvant radiotherapy in this setting.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Im Verbund von AGAPLESION, Zeisigwaldstrasse 101, 09130, Chemnitz, Germany.
| | - Yasmine Coressel
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Rainer Koch
- Formerly Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Löscherstrasse 18, 01309, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Tobias Hölscher
- Department of Radiation Oncology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Froehner M. EDITORIAL COMMENT. Urology 2021; 155:76. [PMID: 34489007 DOI: 10.1016/j.urology.2021.05.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/09/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Michael Froehner
- Chairman of the Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, D-09130 Chemnitz, Germany
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Lorenz U, Samaseika Y, Balsmeyer U, Neumann N, Ritter M, Froehner M. Multicystic Prostate Tumor. Urology 2021; 157:41. [PMID: 34139252 DOI: 10.1016/j.urology.2021.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/02/2021] [Accepted: 06/02/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ulrike Lorenz
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Yury Samaseika
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Ulf Balsmeyer
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Nikolai Neumann
- Radiological Practice, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | | | - Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
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Froehner M, Koch R, Heberling U, Borkowetz A, Hübler M, Novotny V, Wirth MP, Thomas C. Decreasing Non-bladder-cancer Mortality After Radical Cystectomy. EUR UROL SUPPL 2021; 29:15-18. [PMID: 34337529 PMCID: PMC8317886 DOI: 10.1016/j.euros.2021.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 12/01/2022] Open
Abstract
Life expectancy is increasing in many parts of the world. Using proportional hazard models for competing risks, we investigated whether this increase has changed outcomes after radical cystectomy in a sample of 1419 consecutive patients treated between 1993 and 2018. During the observation period, the mean age and the proportion of patients with American Society of Anesthesiologists physical status class 3 or 4 increased, whereas the proportion of patients with heart disease decreased. Competing mortality (causes other than bladder cancer) decreased in all subgroups (hazard ratios [HRs] per year ranged from 0.931 to 0.963) and after controlling for increasing age (HRs ranged from 1.018 to 1.081). In an optimal model resulting from an analysis including age (HR per year 1.048, 95% confidence interval [CI] 1.027–1.070; p < 0.0001), comorbidity, tumor-related variables, body mass index, (neoadjuvant and adjuvant) chemotherapy and smoking status, the HR per increment for year of surgery was 0.928 (95% CI 0.886–0.973; p = 0.0019). The effect of year of surgery was greater than the decrease in competing mortality that may be expected with increasing life expectancy (4 yr for females, 6 yr for males). Patient summary In a review of data for 1993–2018, we found that death from other causes after removal of the bladder (radical cystectomy) for bladder cancer decreased over time. This decreasing trend might increase the age limit at which bladder cancer patients can benefit from radical cystectomy in the future.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
- Corresponding author. Current address: Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, D-09130 Chemnitz, Germany. Tel.: +49 371 4301701; Fax: +49 351 4301704.
| | - Rainer Koch
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Vladimir Novotny
- Department of Urology, Städtisches Klinikum Görlitz, Görlitz, Germany
| | - Manfred P. Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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Froehner M, Koch R, Graefen M. Re: Nicolas Mottet, Roderick C.N. van den Bergh, Erik Briers, et al. EAU-EANM-ESTRO-ESUR-SIOG Guidelines on Prostate Cancer-2020 Update. Part 1: Screening, Diagnosis, and Local Treatment with Curative Intent. Eur Urol 2021;79:243-62: Comorbidity Measurement in Patients with Prostate Cancer. Eur Urol 2021; 79:e138. [PMID: 33612374 DOI: 10.1016/j.eururo.2021.02.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Rainer Koch
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Markus Graefen
- Martini Clinic, Prostate Cancer Centre, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Hoberück S, Löck S, Winzer R, Zöphel K, Froehner M, Fedders D, Kotzerke J, Hölscher T. [ 68Ga]Ga-PSMA-11 PET before and after initial long-term androgen deprivation in patients with newly diagnosed prostate cancer: a retrospective single-center study. EJNMMI Res 2020; 10:135. [PMID: 33159278 PMCID: PMC7647983 DOI: 10.1186/s13550-020-00723-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/21/2020] [Indexed: 01/25/2023] Open
Abstract
Purpose The study aimed to evaluate the effect of androgen deprivation therapy (ADT) on PSMA imaging and its correlation to the PSA concentration by comparing qualitative and quantitative parameters: SUVmax, SUVmean, PSMA-derived tumor volume (PSMA-TV), total lesion PSMA (TL-PSMA) and molecular imaging (mi)PSMA score.
Methods Retrospective analysis of 21 therapy-naïve patients with oligometastatic prostate cancer (median age 70 years) who underwent either [68Ga]Ga-PSMA-11-PET/CT or -PET/MRI before initiation of (T1) as well as during ADT (T2). The median duration of ADT was 155 days (range 61–289 days). All lesions were analyzed using several qualitative and quantitative PET parameters. Results A total of 109 PSMA-positive lesions (24 intraprostatic, 56 lymphonodal and 29 osseous) were visually detected at any of the examinations, while at T2, two new bone lesions were detected in one patient. During ADT, all patients experienced a decrease in their PSA level (median: 29.1 before vs. 0.71 after; p < 0.001). During long-term ADT, a relevant decrease in lesion count occurred, especially in patients with a T2 PSA value < 1 ng/ml (median: 4 vs. 0.9; p = 0.007) and PSMA expression, which resulted in miN- and/or miM-downstaging in 11 patients (52.7%). All analyzed PET parameters correlated strongly with each other. The PSA level at T2 correlated modestly with the decrease in PSMA expression and its derived volumes. Conclusion Post-ADT scans detected, especially in patients with a residual PSA < 1 ng/ml, fewer PSMA-positive lesions with overall lower PSMA expression, regardless of primary tumor site or metastatic sites. None of the PET parameters has proven to be superior, as they all correlated modestly with the PSA value at T2. Thus, the simply acquirable miPSMA score seems to be the most suitable for evaluating the effect of ADT on PSMA expression.
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Affiliation(s)
- Sebastian Hoberück
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Robert Winzer
- Department of Radiology, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Nuclear Medicine, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Michael Froehner
- Department of Urology, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany.,Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Dieter Fedders
- Department of Radiology, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Tobias Hölscher
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany.,Department of Radiotherapy and Radiation Oncology, Faculty of Medicine, University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
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Sünder AK, Stiller U, Wittmann J, Froehner M. Extraadrenal pheochromocytoma masquerading as renal tumor. Urol Case Rep 2020; 33:101321. [PMID: 33102023 PMCID: PMC7573843 DOI: 10.1016/j.eucr.2020.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 06/22/2020] [Indexed: 12/02/2022] Open
Abstract
An otherwise healthy 43-year old woman presented with a large upper pole mass of the left kidney. Transabdominal left-sided nephrectomy including adrenalectomy was performed. Histopathological examination revealed extraadrenal pheochromocytoma with infiltration of the kidney. Awareness of this rare condition could avoid potentially dangerous cardiovascular complications during surgery.
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Affiliation(s)
| | - Uta Stiller
- Radiological Practice, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, D-09130, Chemnitz, Germany
| | - Jörg Wittmann
- Center for Histopathology, Unritzstraße 21d, D-09117, Chemnitz, Germany
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Baldauf A, Koch R, Heberling U, Thomas C, Froehner M. Re: J. Alfred Witjes, Harman Max Bruins, Richard Cathomas, et al. European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2020 Guidelines. Eur Urol 2020;79:82-104. Eur Urol 2020; 79:e29. [PMID: 32819787 DOI: 10.1016/j.eururo.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/02/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Anka Baldauf
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Rainer Koch
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
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Kreuz M, Otto DJ, Fuessel S, Blumert C, Bertram C, Bartsch S, Loeffler D, Puppel SH, Rade M, Buschmann T, Christ S, Erdmann K, Friedrich M, Froehner M, Muders MH, Schreiber S, Specht M, Toma MI, Benigni F, Freschi M, Gandaglia G, Briganti A, Baretton GB, Loeffler M, Hackermüller J, Reiche K, Wirth M, Horn F. ProstaTrend-A Multivariable Prognostic RNA Expression Score for Aggressive Prostate Cancer. Eur Urol 2020; 78:452-459. [PMID: 32631745 DOI: 10.1016/j.eururo.2020.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 06/02/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Prostate cancer (PCa) is the most prevalent solid cancer among men in Western Countries. The clinical behavior of localized PCa is highly variable. Some cancers are aggressive leading to death, while others can even be monitored safely. Hence, there is a high clinical need for precise biomarkers for identification of aggressive disease in addition to established clinical parameters. OBJECTIVE To develop an RNA expression-based score for the prediction of PCa prognosis that facilitates clinical decision making. DESIGN, SETTING, AND PARTICIPANTS We assessed 233 tissue specimens of PCa patients with long-term follow-up data from fresh-frozen radical prostatectomies (RPs), from formalin-fixed and paraffin-embedded RP specimens and biopsies by transcriptome-wide next-generation sequencing and customized expression microarrays. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We applied Cox proportional hazard models to the cohorts from different platforms and specimen types. Evidence from these models was combined by fixed-effect meta-analysis to identify genes predictive of the time to death of disease (DoD). Genes were combined by a weighted median approach into a prognostic score called ProstaTrend and transferred for the prediction of biochemical recurrence (BCR) after RP in an independent cohort of The Cancer Genome Atlas (TCGA). RESULTS AND LIMITATIONS ProstaTrend comprising ∼1400 genes was significantly associated with DoD in the training cohort of PCa patients treated by RP (leave-one-out cross-validation, Cox regression: p=2e-09) and with BCR in the TCGA validation cohort (Cox regression: p=3e-06). The prognostic impact persisted after multivariable Cox regression analysis adjusting for Gleason grading group (GG) ≥3 and resection status (p=0.001; DoD, training cohort) and for GG≥3, pathological stage ≥T3, and resection state (p=0.037; BCR, validation cohort). CONCLUSIONS ProstaTrend is a transcriptome-based score that predicts DoD and BCR in cohorts of PCa patients treated with RP. PATIENT SUMMARY ProstaTrend provides molecular patient risk stratification after radical prostatectomy.
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Affiliation(s)
- Markus Kreuz
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | - Dominik J Otto
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Susanne Fuessel
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Conny Blumert
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Catharina Bertram
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Sophie Bartsch
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Dennis Loeffler
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Sven-Holger Puppel
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Michael Rade
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Tilo Buschmann
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Sabina Christ
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Kati Erdmann
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Dresden, Germany
| | - Maik Friedrich
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
| | - Michael Froehner
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Urology, Zeisigwaldkliniken Bethanien, Chemnitz, Germany
| | - Michael H Muders
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Rudolf-Becker-Laboratory for Prostate Cancer Research, Institute of Pathology, University of Bonn Medical Center, Bonn, Germany
| | | | - Michael Specht
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany
| | - Marieta I Toma
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Fabio Benigni
- Department of Urology and Division of Experimental Oncology, URI, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Freschi
- Pathology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Gandaglia
- Department of Urology and Division of Experimental Oncology, URI, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Briganti
- Department of Urology and Division of Experimental Oncology, URI, Vita-Salute San Raffaele University, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gustavo B Baretton
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Markus Loeffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Leipzig, Germany
| | | | - Kristin Reiche
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany.
| | - Manfred Wirth
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Friedemann Horn
- Department of Diagnostics, Fraunhofer Institute for Cell Therapy and Immunology, Leipzig, Germany; Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, Leipzig, Germany
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15
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Froehner M, Koch R, Heberling U, Borkowetz A, Hübler M, Novotny V, Wirth MP, Thomas C. Validation of a Questionnaire-Suitable Comorbidity Index in Patients Undergoing Radical Cystectomy. Urol Int 2020; 104:567-572. [PMID: 32541139 DOI: 10.1159/000507100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/08/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the capability of a modified self-administrable comorbidity index recommended in the standard sets for neoplastic diseases published by the International Consortium for Health Outcomes Measurement (ICHOM) to predict 90-day and long-term mortality after radical cystectomy. METHODS A single-center series of 1,337 consecutive patients who underwent radical cystectomy for muscle-invasive or high-risk non-muscle-invasive urothelial or undifferentiated bladder cancer were stratified by the modified self-administrable comorbidity index and Charlson score, respectively. Multivariate logit models (for 90-day mortality) and proportional-hazards models (for overall and non-bladder cancer mortality) were used for statistical workup. RESULTS Considering 90-day mortality, both comorbidity indexes contributed independent information when analyzed together with age (p < 0.0001). The Charlson score performed slightly better (area under the curve [AUC] 0.74 vs. 0.72 for the ICHOM-recommended comorbidity index). Considering 5-year overall mortality in 727 patients with complete observation, the performance of both measures was similar (AUC 0.63 vs. 0.62, including age AUC 0.66 for both indexes). With 6-sided stratifications, the modified self-administrable comorbidity index separated the risk groups slightly better (p values for directly neighboring curves: 0.0068-0.1043 vs. 0.0001-0.8100). CONCLUSION The ICHOM-recommended modified self-administrable comorbidity index is capable of predicting 90-day mortality and long-term non-bladder cancer mortality after radical cystectomy similarly to the commonly used Charlson score.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany, .,Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany,
| | - Rainer Koch
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Vladimir Novotny
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.,Department of Urology, Städtisches Klinikum Görlitz, Görlitz, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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16
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Erdmann K, Salomo K, Klimova A, Heberling U, Lohse-Fischer A, Fuehrer R, Thomas C, Roeder I, Froehner M, Wirth MP, Fuessel S. Urinary MicroRNAs as Potential Markers for Non-Invasive Diagnosis of Bladder Cancer. Int J Mol Sci 2020; 21:ijms21113814. [PMID: 32471285 PMCID: PMC7312501 DOI: 10.3390/ijms21113814] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/21/2022] Open
Abstract
Currently, voided urine cytology (VUC) serves as the gold standard for the detection of bladder cancer (BCa) in urine. Despite its high specificity, VUC has shortcomings in terms of sensitivity. Therefore, alternative biomarkers are being searched, which might overcome these disadvantages as a useful adjunct to VUC. The aim of this study was to evaluate the diagnostic potential of the urinary levels of selected microRNAs (miRs), which might represent such alternative biomarkers due to their BCa-specific expression. Expression levels of nine BCa-associated microRNAs (miR-21, -96, -125b, -126, -145, -183, -205, -210, -221) were assessed by quantitative PCR in urine sediments from 104 patients with primary BCa and 46 control subjects. Receiver operating characteristic (ROC) curve analyses revealed a diagnostic potential for miR-96, -125b, -126, -145, -183, and -221 with area under the curve (AUC) values between 0.605 and 0.772. The combination of the four best candidates resulted in sensitivity, specificity, positive and negative predictive values (NPV), and accuracy of 73.1%, 95.7%, 97.4%, 61.1%, and 80.0%, respectively. Combined with VUC, sensitivity and NPV could be increased by nearly 8%, each surpassing the performance of VUC alone. The present findings suggested a diagnostic potential of miR-125b, -145, -183, and -221 in combination with VUC for non-invasive detection of BCa in urine.
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Affiliation(s)
- Kati Erdmann
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
- National Center for Tumor Diseases (NCT), 01307 Dresden, Germany; (A.K.); (I.R.)
| | - Karsten Salomo
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Anna Klimova
- National Center for Tumor Diseases (NCT), 01307 Dresden, Germany; (A.K.); (I.R.)
- Institute for Medical Informatics and Biometrics, Technische Universität Dresden, 01307 Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Andrea Lohse-Fischer
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Romy Fuehrer
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Christian Thomas
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Ingo Roeder
- National Center for Tumor Diseases (NCT), 01307 Dresden, Germany; (A.K.); (I.R.)
- Institute for Medical Informatics and Biometrics, Technische Universität Dresden, 01307 Dresden, Germany
| | - Michael Froehner
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Manfred P. Wirth
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
| | - Susanne Fuessel
- Department of Urology, Technische Universität Dresden, 01307 Dresden, Germany; (K.E.); (K.S.); (U.H.); (A.L.-F.); (R.F.); (C.T.); (M.F.); (M.P.W.)
- Correspondence: ; Tel.: +49-351-45814544
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17
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Froehner M, Koch R, Hübler M, Lindner M, Wirth MP, Thomas C. Quantifying the Relationship Between Increasing Life Expectancy and Nonprostate Cancer Mortality After Radical Prostatectomy. Urology 2020; 142:174-178. [PMID: 32333981 DOI: 10.1016/j.urology.2020.04.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To investigate the relationship between increasing life expectancy and nonprostate cancer (competing) mortality after radical prostatectomy. PATIENTS AND METHODS We studied a single-center sample of 6809 consecutive patients who underwent radical prostatectomy between 1992 and 2016 with a median age of 65 years and a median follow-up of 7.9 years. Multivariate competing risk analyses were performed with competing mortality as endpoint. Linear trends over the years of surgery for 5-year competing mortality rates and for mean ages were calculated using linear regression analyses. We estimated the number of live years gained over time using a heuristic model-based calculation: (hazard ratio year of surgery) 24 calendar years × (hazard ratio age at surgery) gained life years = 1. RESULTS After controlling for age, nonprostate cancer mortality decreased significantly during the observation period. Accumulated over the 24 years, this decrease of mortality corresponded to the effect of 6.3 years of calendric age. Most of the decrease in nonprostate cancer mortality (predominantly attributable to noncancer causes of death) was seen in patients aged 65 years or older (8.1 years gained), whereas there was only a marginal decrease in patients younger than 65 years (only 1 year gained). The decrease in nonprostate cancer mortality was accompanied by a slight increase of mean age at surgery (2.7 years) that did not nearly compensate the decreasing risk. CONCLUSION Clinicians should be aware of the decreasing competing mortality risk in elderly candidates for radical prostatectomy in order to avoid undertreatment.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Rainer Koch
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Departments of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Marcus Lindner
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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18
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Froehner M, Koch R, Thomas C. Re: Giorgio Gandaglia G, Peter Albers, Per-Anders Abrahamsson, et al. Structured Population-based Prostate-specific Antigen Screening for Prostate Cancer: The European Association of Urology Position in 2019. Eur Urol 2019;76:142-50. Eur Urol 2019; 77:e30. [PMID: 31836073 DOI: 10.1016/j.eururo.2019.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany.
| | - Rainer Koch
- Department of Urology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
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19
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Froehner M, Koch R, Farahzadi S, Heberling U, Borkowetz A, Twelker L, Baretton GB, Wirth MP, Thomas C. Long-Term Mortality in Patients with Positive Lymph Nodes at the Time of Radical Prostatectomy. Urol Int 2019; 103:427-432. [PMID: 31661703 DOI: 10.1159/000500961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/26/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to determine prognostic factors and to provide long-term mortality data in patients with positive lymph nodes at the time of radical prostatectomy in a sample with long-term follow-up. METHODS A total of 527 patients with complete data sets treated in the years 1992-2014 were studied. The median follow-up was 7.2 years. The median number of removed lymph nodes was 15. Age, year of surgery, Gleason score, local tumor stage, prostate-specific antigen level, lymph node density, lymph node count and the number of positive lymph nodes were included in multivariable competing risk analyses with prostate cancer mortality as endpoint. RESULTS After 20 years, 28% of patients (95% CI 20-36%) died from non-prostate cancer (competing) causes, whereas 29% (95% CI 23-36%) died from prostate cancer. Only lymph node density (stratified by the median of 11.1%; hazard ratio [HR] 1.66, 95% CI 1.04-2.64, p = 0.0340) and Gleason score (8-10 vs. <8: HR 5.97, 95% CI 3.18-11.23, p < 0.0001) were independent predictors of prostate cancer mortality. Patients with a Gleason score <8 and a lymph node density < median had a 20-year prostate cancer mortality of only 5% (95% CI 0-10%), whereas this rate in patients with Gleason score 8-10 and a lymph node density ≥ median was 44% (95% CI 32-56%), p < 0.0001. CONCLUSIONS Mortality in patients with positive lymph nodes was determined by tumor aggressiveness and the relative extent of spread; neither the year of surgery nor the number of removed lymph nodes was associated with outcome. Patients with a lymph node density of <11.1% and a Gleason score <8 had an excellent long-term outcome.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany,
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Samaneh Farahzadi
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Lars Twelker
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.,Department of Urology, Franziskus Hospital, Bielefeld, Germany
| | - Gustavo B Baretton
- Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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20
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Froehner M, Muallah D, Koch R, Hübler M, Borkowetz A, Heberling U, Huber J, Wirth MP, Thomas C. Socioeconomic Status-Related Parameters as Predictors of Competing (Non-Bladder Cancer) Mortality after Radical Cystectomy. Urol Int 2019; 104:62-69. [PMID: 31639810 DOI: 10.1159/000502781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/12/2019] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To investigate the impact of socioeconomic status-related parameters on competing (non-bladder cancer) mortality after radical cystectomy. PATIENTS AND METHODS A total of 1,268 consecutive patients who underwent radical cystectomy for urothelial or undifferentiated bladder cancer at our institution between 1993 and 2016 with a mean age of 69 years (median 70 years) were studied. The mean -follow-up of the censored patients was 7.2 years (median 5.7 years). Proportional hazard models for competing risk were used to identify predictors of non-bladder cancer (competing) mortality. The following parameters were included into multivariate analyses: age, American Society of Anesthesiologists physical status classification, Charlson score, gender, level of education, smoking status, marital status, local tumour stage, lymph node status, adjuvant and neoadjuvant chemotherapy. RESULTS Besides age and both comorbidity classifications, the socioeconomic status-related parameters gender (female versus male, hazard ratio [HR] 0.58, 95% CI 0.40-0.84, p = 0.0042), level of education (university degree or master craftsman versus others, HR 0.76, 95% CI 0.56-0.1.03, p = 0.0801), smoking status (current smoking versus others, HR 1.47, 95% CI 1.10-1.96, p = 0.0085) and marital status (married versus others, HR 0.68, 95% CI 0.50-0.92, p = 0.0133) were independent predictors of competing mortality after radical cystectomy. If considered in combination (multiplication of HRs), the prognostic impact of socioeconomic parameters superseded that of the investigated comorbidity classifications. CONCLUSION Socioeconomic status-related parameters may provide important information on the long-term competing mortality risk after radical cystectomy supplementary to chronological age and comorbidity.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Chemnitz, Germany, .,Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany,
| | - David Muallah
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital "Carl Gustav Carus," Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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21
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Borkowetz A, Froehner M, Rauner M, Conrad S, Erdmann K, Mayr T, Datta K, Hofbauer LC, Baretton GB, Wirth M, Fuessel S, Toma M, Muders MH. Neuropilin‐2 is an independent prognostic factor for shorter cancer‐specific survival in patients with acinar adenocarcinoma of the prostate. Int J Cancer 2019; 146:2619-2627. [DOI: 10.1002/ijc.32679] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/24/2019] [Accepted: 08/07/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | | | - Martina Rauner
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III Technische Universität Dresden Germany
| | - Stefanie Conrad
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III Technische Universität Dresden Germany
| | - Kati Erdmann
- Department of Urology Technische Universität Dresden Germany
| | - Thomas Mayr
- Institute of Pathology, Technische Universität Dresden Germany
| | - Kaustubh Datta
- Department of Biochemistry and Molecular Biology University of Nebraska Medical Center Omaha NE
| | - Lorenz C. Hofbauer
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III Technische Universität Dresden Germany
| | - Gustavo B. Baretton
- Institute of Pathology, Technische Universität Dresden Germany
- Tumor and Normal Tissue Bank of the University Cancer Center (UCC), University Hospital and Faculty of Medicine, Technische Universität Dresden Dresden Germany
| | - Manfred Wirth
- Department of Urology Technische Universität Dresden Germany
| | - Susanne Fuessel
- Department of Urology Technische Universität Dresden Germany
| | - Marietta Toma
- Institute of Pathology, Technische Universität Dresden Germany
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22
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Hoberück S, Michler E, Wunderlich G, Löck S, Hölscher T, Froehner M, Braune A, Ivan P, Seppelt D, Zöphel K, Kotzerke J. 68Ga-RM2 PET in PSMA- positive and -negative prostate cancer patients. Nuklearmedizin 2019; 58:352-362. [PMID: 31443113 DOI: 10.1055/a-0990-8898] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
AIM: 68Ga-PSMA-11 is the gold standard for molecular imaging of prostate cancer. However, recurrent tumor manifestations or metastases cannot be detected in every case. Therefore, we investigated if there is an additive value of the gastrin-releasing peptide receptor (GRP-R) ligand 68Ga-RM2 compared to the well-established 68Ga-PSMA-11 in patients with (Group 1) and without (Group 2) pathologic PSMA-expression in different tumor stages. PATIENTS AND METHODS Sixteen men (median age: 74 years, range 50-80 years) with prostate cancer in different stages who had a recent negative (n = 8) or pathologic (n = 8) PSMA PET underwent a subsequent 68Ga-RM2 PET. Both examinations were analyzed qualitatively and quantitatively and compared in terms of pathologic and physiologic tracer distribution. RESULTS None of the PSMA-negative patients showed any pathological RM2-accumulation. Pathologic PSMA-uptake was observed in 8 patients of whom 5 had pathologic RM2-uptake. The number of patients with a local recurrence was equal in both scans (n = 3). Bone metastases and lymph node metastases were detected in less patients in RM2 PET compared to PSMA PET (n = 4 vs. 7 and n = 2 vs. 5, respectively). In one patient, PSMA-positive liver metastases were not detected in RM2. RM2 PET revealed two additional lesions indicative for bone metastases in two patients with multiple PSMA-positive bone metastases, which had no therapeutic consequence. CONCLUSION At least in our small and heterogeneous patient population, 68Ga-RM2 showed no clinically relevant, additional benefit compared to 68Ga-PSMA-11 PET.
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Affiliation(s)
- Sebastian Hoberück
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Enrico Michler
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Gerd Wunderlich
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Steffen Löck
- OncoRay - National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden - Rossendorf, Dresden, Germany
| | - Tobias Hölscher
- Department of Radiotherapy and Radiation Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Michael Froehner
- Department of Urology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Anja Braune
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Platzek Ivan
- Department of Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Danilo Seppelt
- Department of Radiology, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Klaus Zöphel
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
| | - Jörg Kotzerke
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Germany
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Froehner M, Koch R, Heberling U, Hübler M, Novotny V, Borkowetz A, Wirth MP, Thomas C. Which comorbidity classification is best suited to identify patients at risk for 90-day and long-term non-bladder cancer mortality after radical cystectomy? World J Urol 2019; 38:695-702. [PMID: 31267181 DOI: 10.1007/s00345-019-02860-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 06/24/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE There is no consensus on the best comorbidity measure in candidates for radical cystectomy. The aim of this study was to identify tool best suited to identify patients at risk for 90-day or premature long-term non-bladder cancer mortality. METHODS We studied 1268 patients who underwent radical cystectomy to identify patients at risk for 90-day and later-than-90-day mortality, respectively. Six classifications were investigated as possible predictors of both types of mortality. Multivariable models including age as continuous variable and each classification separately were calculated. A heuristic ranking was based on the evaluation of the hazard ratios, p values, Akaike's information criteria, and concerning the logit models also the areas under the curve. RESULTS The median follow-up was 5.7 years. Within 90 days after surgery, the mortality rate was 4.2%. The greatest independent contribution concerning the prediction of 90-day mortality was seen with the American Society of Anesthesiologists (ASA) physical status classification (classes 3-4 versus 1-2: hazard ratio 7.98, 95% confidence interval 3.54-18.01, p < 0.0001). In the longer term, countable diseases (Canadian Cardiovascular Society classification of angina pectoris, conditions contributing the Charlson score) were of greater importance. The results of heuristic ranking were confirmed by multivariate analyses including age and all classifications together. CONCLUSIONS Besides to chronological age, clinicians should pay particular attention to the ASA classification to identify patients at risk for 90-day mortality after radical cystectomy, whereas long-term mortality is more determined by countable comorbid diseases.
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Affiliation(s)
- Michael Froehner
- Department of Urology, Zeisigwaldkliniken Bethanien Chemnitz, Zeisigwaldstrasse 101, 09130, Chemnitz, Germany.
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Vladimir Novotny
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
- Department of Urology, Städtisches Klinikum Görlitz, Girbigsdorfer Strasse 1-3, 02828, Görlitz, Germany
| | - Angelika Borkowetz
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Froehner M, Thomas C. Re: Sebastian Berg, Alexander P. Cole, Marieke J. Krimphove, et al. Comparative Effectiveness of Radical Prostatectomy Versus External Beam Radiation Therapy Plus Brachytherapy in Patients with High-risk Localized Prostate Cancer. Eur Urol 2019;75:552-5. Eur Urol 2019; 76:e75. [PMID: 31130432 DOI: 10.1016/j.eururo.2019.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 05/14/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
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25
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Froehner M, Koch R, Hübler M, Heberling U, Novotny V, Zastrow S, Wirth MP. Validation of the Preoperative Score to Predict Postoperative Mortality in Patients Undergoing Radical Cystectomy. Eur Urol Focus 2019; 5:197-200. [DOI: 10.1016/j.euf.2017.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/25/2017] [Accepted: 05/05/2017] [Indexed: 10/19/2022]
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26
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Stasik S, Salomo K, Heberling U, Froehner M, Sommer U, Baretton GB, Ehninger G, Wirth MP, Thiede C, Fuessel S. Evaluation of TERT promoter mutations in urinary cell-free DNA and sediment DNA for detection of bladder cancer. Clin Biochem 2018; 64:60-63. [PMID: 30528938 DOI: 10.1016/j.clinbiochem.2018.11.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 11/12/2018] [Accepted: 11/26/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cell-free DNA (cfDNA) is proposed to be a valuable source of biomarkers in liquid biopsies for various diseases as it is supposed to partially originate from tumor cells. However, data about the diagnostic implications of cfDNA in urine for the detection of bladder cancer (BCa) is sparse. METHODS We evaluated the usability of urinary cfDNA for diagnostic purposes compared to urine sediment DNA (sDNA) in 53 BCa patients and 36 control subjects by analyzing two abundant point-mutations (C228T/C250T) in the TERT promoter using Next-Generation Sequencing. RESULTS Mutations were detected in 77% of the urinary sDNA compared to 63% of the cfDNA samples. Moreover, the TERT mutation allele frequencies (MAF) were highly correlated in cfDNA and sDNA. In comparison, the accuracy of the TERT assay was higher in sDNA (84%) compared to cfDNA or voided urine cytology (both 77%). Interestingly, MAFs from leukocyte-rich urines were higher in cfDNA than in sDNA, indicating a diagnostic advantage of cfDNA in such urines. CONCLUSIONS Urine-based mutation detection has the ability to augment and surpass voided urine cytology as the current gold-standard for the non-invasive detection and surveillance of BCa. The analysis of cell-free DNA provides no general diagnostic advantage compared to urine sediment DNA.
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Affiliation(s)
- Sebastian Stasik
- Medical Department I, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Karsten Salomo
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Michael Froehner
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Ulrich Sommer
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany
| | - Gustavo B Baretton
- Institute of Pathology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany; Tumor and normal tissue bank of Universitäts KrebsCentrum (UCC), University Hospital and Faculty of Medicine, Technische Universität Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Gerhard Ehninger
- Medical Department I, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Christian Thiede
- Medical Department I, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany; German Cancer Consortium (DKTK), Dresden, Germany
| | - Susanne Fuessel
- Department of Urology, University Hospital and Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; National Center for Tumor Diseases (NCT), Partner site Dresden, Dresden, Germany.
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27
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Zieschang H, Koch R, Wirth M, Froehner M. Leiomyosarcoma of the Urinary Bladder in Adult Patients: A Systematic Review of the Literature and Meta-Analysis. Urol Int 2018; 102:96-101. [DOI: 10.1159/000494357] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
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28
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Froehner M, Koch R, Hübler M, Heberling U, Novotny V, Zastrow S, Hakenberg OW, Wirth MP. Predicting 90-day and long-term mortality in octogenarians undergoing radical cystectomy. BMC Urol 2018; 18:91. [PMID: 30348141 PMCID: PMC6198515 DOI: 10.1186/s12894-018-0402-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 10/04/2018] [Indexed: 01/20/2023] Open
Abstract
Background Radical cystectomy bears a considerable perioperative mortality risk particularly in elderly patients. In this study, we searched for predictors of perioperative and long-term competing (non-bladder cancer) mortality in elderly patients selected for radical cystectomy. Methods We stratified 1184 consecutive patients who underwent radical cystectomy for high risk superficial or muscle-invasive urothelial or undifferentiated carcinoma of bladder into two groups (age < 80 years versus 80 years or older). Multivariable and cox proportional hazards models were used for data analysis. Results Whereas Charlson score and the American Society of Anesthesiologists (ASA) physical status classification (but not age) were independent predictors of 90-day mortality in younger patients, only age predicted 90-day mortality in patients aged 80 years or older (odds ratio per year 1.24, p = 0.0422). Unlike in their younger counterparts, neither age nor Charlson score or ASA classification were predictors of long-term competing mortality in patients aged 80 years or older (hazard ratios 1.07-1.10, p values 0.21-0.77). Conclusions This data suggest that extrapolations of perioperative mortality or long-term mortality risks of younger patients to octogenarians selected for radical cystectomy should be used with caution. Concerning 90-day mortality, chronological age provided prognostic information whereas comorbidity did not.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany.
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Ulrike Heberling
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Vladimir Novotny
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Stefan Zastrow
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
| | - Oliver W Hakenberg
- Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055, Rostock, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstrasse 74, D-01307, Dresden, Germany
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29
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Heberling U, Koch R, Hübler M, Baretton G, Hakenberg O, Wirth M, Froehner M. Gender and Mortality after Radical Cystectomy: Competing Risk Analysis. Urol Int 2018; 101:293-299. [DOI: 10.1159/000487445] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/02/2018] [Indexed: 11/19/2022]
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30
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Borkowetz A, Renner T, Platzek I, Toma M, Herout R, Baunacke M, Groeben C, Huber J, Laniado M, Baretton G, Froehner M, Zastrow S, Wirth MP. Evaluation of Transperineal Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy Compared to Transrectal Systematic Biopsy in the Prediction of Tumour Aggressiveness in Patients with Previously Negative Biopsy. Urol Int 2018; 102:20-26. [PMID: 30149386 DOI: 10.1159/000492495] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 07/27/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We compared the transperineal MRI/ultrasound-fusion biopsy (fusPbx) to transrectal systematic biopsy (sysPbx) in patients with previously negative biopsy and investigated the prediction of tumour aggressiveness with regard to radical prostatectomy (RP) specimen. MATERIAL AND METHODS A total of 710 patients underwent multiparametric magnetic resonance imaging (mpMRI), which was evaluated in accordance with Prostate Imaging Reporting and Data System (PI-RADS). The maximum PI-RADS (maxPI-RADS) was defined as the highest PI-RADS of all lesions detected in mpMRI. In case of proven prostate cancer (PCa) and performed RP, tumour grading of the biopsy specimen was compared to that of the RP. Significant PCa (csPCa) was defined according to Epstein criteria. RESULTS Overall, scPCa was detected in 40% of patients. The detection rate of scPCa was 33% for fusPbx and 25% for sysPbx alone (p < 0.005). Patients with a maxPI-RADS ≥3 and a prostate specific antigen (PSA)-density ≥0.2 ng/mL2 harboured more csPCa than those with a PSA-density < 0.2 ng/mL2 (41% [33/81] vs. 20% [48/248]; p < 0.001). Compared to the RP specimen (n = 140), the concordance of tumour grading was 48% (γ = 0.57), 36% (γ = 0.31) and 54% (γ = 0.6) in fusPbx, sysPbx and comPbx, respectively. CONCLUSIONS The combination of fusPbx and sysPbx outperforms both biopsy modalities in patients with re-biopsy. Additionally, the PSA-density may represent a predictor for csPCa in patients with maxPI-RADS ≥3.
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Affiliation(s)
| | - Theresa Renner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Ivan Platzek
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Marieta Toma
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Roman Herout
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Christer Groeben
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Johannes Huber
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Michael Laniado
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Gustavo Baretton
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Michael Froehner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Stefan Zastrow
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, Technische Universität Dresden, Dresden, Germany
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Williams SB, Kamat AM, Chamie K, Froehner M, Wirth MP, Wiklund PN, Black PC, Steinberg GD, Boorjian SA, Daneshmand S, Goebell PJ, Pohar KS, Shariat SF, Thalmann GN. Systematic Review of Comorbidity and Competing-risks Assessments for Bladder Cancer Patients. Eur Urol Oncol 2018; 1:91-100. [PMID: 30345422 DOI: 10.1016/j.euo.2018.03.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Context Radical cystectomy continues to be associated with a significant risk of morbidity and all-cause mortality (ACM). Practice pattern data demonstrating underuse of surgery for patients with muscle-invasive and high-risk non-muscle invasive bladder cancer (BC) have been linked to the advanced age and higher comorbidity status of such patients, which suggests that rates of ACM as well as cancer-specific mortality should be incorporated into patient counseling and guideline recommendations. Objective To review the literature on risk assessment tools for preoperative comorbidity in BC that may aid in treatment decision-making. Evidence acquisition A systematic search was conducted using Ovid and Medline according to Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines to identify studies between 1970 and 2017 reporting on comorbidity risk assessment (CRA) tools for BC. Prospective and retrospective studies were included. Evidence synthesis There are no published randomized control trials comparing CRA tools for BC. Patients undergoing radical cystectomy with combined high-risk comorbidity and performance scores may face up to a sevenfold greater risk of other-cause mortality compared to those with low scores. The Charlson Comorbidity Index is one of the most widely studied indices for 90-d perioperative mortality and overall and cancer-specific survival, with an area under the receiver operating characteristic curve of up to 0.810. Prospective studies of CRA tools for BC have consistently shown that patients with higher comorbidity have worse outcomes. While not specific for BC, comorbidity indices provide useful assessment of competing risks. Competing-risks assessment tools are lacking, with limited studies assessing the impact of these tools on treatment decision-making by patients and providers. We provide the impetus for incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients. Conclusions CRA tools should be incorporated into preoperative treatment counseling and the assessment of postoperative outcomes. While retrospective evidence supports the use of CRA tools for BC, further comparative studies evaluating the effectiveness of these tools and identifying the patients most likely to benefit from a treatment according to competing-risks assessment are needed. Patient summary In this review we explored the clinical evidence for comorbidity risk assessment tools in bladder cancer. We found evidence to support incorporation of comorbidity risks into practice guidelines when discussing treatment options with patients.
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Affiliation(s)
- Stephen B Williams
- Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA, USA
| | - Michael Froehner
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Peter N Wiklund
- Department of Urology, Karolinska University Hospital, Stockholm, Sweden
| | - Peter C Black
- Department of Urologic Science, University of British Columbia, Vancouver, BC, Canada
| | - Gary D Steinberg
- Department of Surgery, Section of Urology, University of Chicago, Chicago, IL, USA
| | | | - Sia Daneshmand
- USC Institute of Urology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Peter J Goebell
- Department of Urology, Friedrich-Alexander University, Erlangen, Germany
| | - Kamal S Pohar
- Department of Urology, Ohio State University, Columbus, OH, USA
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Thiele S, Zimmer A, Göbel A, Rachner TD, Rother S, Fuessel S, Froehner M, Wirth MP, Muders MH, Baretton GB, Jakob F, Rauner M, Hofbauer LC. Role of WNT5A receptors FZD5 and RYK in prostate cancer cells. Oncotarget 2018; 9:27293-27304. [PMID: 29930766 PMCID: PMC6007469 DOI: 10.18632/oncotarget.25551] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 05/11/2018] [Indexed: 01/08/2023] Open
Abstract
Prostate cancer is the most common malignancy in men and has a high propensity to metastasize to bone. WNT5A has recently been implicated in the progression of prostate cancer, however, the receptors that mediate its effects remain unknown. Here, we identified Wnt receptors that are highly expressed in prostate cancer and investigated which of these receptors mediate the anti-tumor effects of WNT5A in prostate cancer in vitro. Extensive in vitro analyses revealed that the WNT5A receptors FZD5 and RYK mediate the anti-tumor effects of WNT5A on prostate cancer cells. Knock-down of FZD5 completely abrogated the anti-proliferative effect of WNT5A in PC3 cells. In contrast, knock-down of RYK and FZD8 did not rescue the inhibition of proliferation after WNT5A overexpression. In contrast, RYK knock-down inhibited the pro-apoptotic effect of WNT5A in PC3 cells by 60%, whereas the knock-down of either FZD5 or FZD8 further stimulated apoptosis after WNT5A overexpression (by 33% and 234%, respectively). Surface plasmon resonance analysis indicated that WNT5A has a 30% stronger binding response to FZD5 than to RYK. Further investigations using a tissue microarray revealed that expression of RYK is increased in advanced prostate cancer tumor stages, but is not associated with survival of prostate cancer patients. In contrast, patients with low local FZD5 expression, in particular in combination with low WNT5A expression, showed a longer disease-specific survival. In conclusion, WNT5A/FZD5 and WNT5A/RYK signaling are both involved in mediating the pro-apoptotic and anti-proliferative effects of WNT5A in prostate cancer.
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Affiliation(s)
- Stefanie Thiele
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Ariane Zimmer
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Andy Göbel
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Tilman D Rachner
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Sandra Rother
- Institute of Materials Science, Max Bergmann Center of Biomaterials, Technische Universität Dresden, Dresden, Germany
| | - Susanne Fuessel
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Michael Froehner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Michael H Muders
- Institute of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Gustavo B Baretton
- Institute of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Franz Jakob
- Orthopedic Center for Musculoskeletal Research, University of Würzburg, Würzburg, Germany
| | - Martina Rauner
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany
| | - Lorenz C Hofbauer
- Division of Endocrinology and Metabolic Bone Diseases, Department of Medicine III, Dresden, Germany.,Center for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany.,German Cancer Consortium (DKTK), partner site Dresden and German Cancer Research Center (DKFZ), Heidelberg, Germany
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Froehner M, Koch R, Hübler M, Heberling U, Novotny V, Zastrow S, Baretton GB, Wirth MP. Selection Effects May Explain Smoking-related Outcome Differences After Radical Cystectomy. Eur Urol Focus 2018; 4:395-398. [DOI: 10.1016/j.euf.2016.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2016] [Revised: 10/02/2016] [Accepted: 10/11/2016] [Indexed: 12/01/2022]
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Froehner M, Koch R, Hübler M, Renner T, Borkowetz A, Zastrow S, Wirth MP. MP12-04 ONLY LESS THAN 10% OF PATIENTS SELECTED FOR RADICAL PROSTATECTOMY REACH THE COMPETING MORTALITY RATE OF THE PROSTATE CANCER INTERVENTION VERSUS OBSERVATION TRIAL (PIVOT). J Urol 2018. [DOI: 10.1016/j.juro.2018.02.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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35
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Borkowetz A, Platzek I, Toma M, Renner T, Froehner M, Zastrow S, Wirth M. MP20-20 BETTER PREDICTION OF TUMOR AGGRESSIVENESS IN MRI/ULTRASOUND-FUSION-BIOPSY COMPARED TO SYSTEMATIC PROSTATE BIOPSY. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Froehner M, Jahn S, Plodeck V, Laniado M, Wirth MP. Chronically Infected Urachal Remnant Mimicking Tumor With Peritoneal Carcinomatosis. Urology 2018; 116:e3-e4. [PMID: 29551620 DOI: 10.1016/j.urology.2018.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 02/22/2018] [Accepted: 03/05/2018] [Indexed: 10/17/2022]
Abstract
A 51-year-old male patient presented with lower abdominal pain persisting since about 1 year. Abdominal computed tomography scan showed a solid tumor interpreted as urachal carcinoma with peritoneal carcinomatosis. Histopathological examination revealed urachal abscess. Awareness of clinical signs and imaging findings of this rare but characteristic condition may avoid emotional distress of patients associated with erroneous suspicion of malignancy.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
| | - Steffen Jahn
- Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Verena Plodeck
- Department of Radiologic Diagnostics, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Michael Laniado
- Department of Radiologic Diagnostics, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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Vetterlein MW, Seisen T, May M, Nuhn P, Gierth M, Mayr R, Fritsche HM, Burger M, Novotny V, Froehner M, Wirth MP, Protzel C, Hakenberg OW, Roghmann F, Palisaar RJ, Noldus J, Pycha A, Bastian PJ, Trinh QD, Xylinas E, Shariat SF, Rink M, Chun FKH, Dahlem R, Fisch M, Aziz A. Effectiveness of Adjuvant Chemotherapy After Radical Cystectomy for Locally Advanced and/or Pelvic Lymph Node–Positive Muscle-invasive Urothelial Carcinoma of the Bladder: A Propensity Score–Weighted Competing Risks Analysis. Eur Urol Focus 2018; 4:252-259. [DOI: 10.1016/j.euf.2016.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 07/04/2016] [Indexed: 12/27/2022]
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38
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Froehner M, Koch R, Hübler M, Renner T, Borkowetz A, Zastrow S, Wirth MP. Only <10% of Patients Selected for Radical Prostatectomy Reach the Competing Mortality Rate of the Prostate Cancer Intervention Versus Observation Trial (PIVOT). Eur Urol Focus 2018; 5:361-364. [PMID: 29426695 DOI: 10.1016/j.euf.2018.01.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 01/08/2018] [Accepted: 01/25/2018] [Indexed: 11/24/2022]
Abstract
In the Prostate Cancer Intervention Versus Observation Trial (PIVOT), surgery was not associated with lower mortality compared with observation. However, the high competing mortality rate of approximately 33% after 10 yr among the PIVOT study population has raised concerns on the generalizability of these results. We investigated 4282 patients who underwent radical prostatectomy at our institution between 1992 and 2010 to determine which subgroups harbored a competing (non-prostate cancer) mortality risk comparable to that of PIVOT and tested several combinations of higher age and comorbidities ("worst case scenarios") to identify subgroups reaching or even superseding the competing mortality rate of the PIVOT population. The competing mortality rate of PIVOT was not reached till an age-adjusted Charlson score of 5 or higher (corresponding to an age of 70-79 yr with diabetes with end-organ damage). Only 8.9% of patients belonged to this high-risk subgroup, and only small subgroups comprising 1-5% patients superseded the competing mortality rate among the PIVOT study population. This data underline that the results of PIVOT should be used with great caution to exclude candidates for radical prostatectomy with comorbidities from curative treatment. PATIENT SUMMARY: Only <10% of patients selected for radical prostatectomy reached the competing mortality rate of approximately 33% observed in the Prostate Cancer Intervention Versus Observation Trial (PIVOT). The results of PIVOT should be used with great caution to exclude patients with concomitant diseases who seem otherwise fit for radical prostatectomy from curative treatment.
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Affiliation(s)
- Michael Froehner
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany.
| | - Rainer Koch
- Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Matthias Hübler
- Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Theresa Renner
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Angelika Borkowetz
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Stefan Zastrow
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
| | - Manfred P Wirth
- Departments of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Dresden, Germany
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Borkowetz A, Renner T, Platzek I, Toma M, Herout R, Baunacke M, Groeben C, Huber J, Laniado M, Baretton G, Froehner M, Zastrow S, Wirth M. Evaluation of Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy in Patients with Low-Risk Prostate Cancer Under Active Surveillance Undergoing Surveillance Biopsy. Urol Int 2018; 100:155-163. [DOI: 10.1159/000486041] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/05/2017] [Indexed: 11/19/2022]
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40
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Froehner M, Koch R, Wirth BMP. Age and Charlson Score. Ann Surg Oncol 2017; 24:677-678. [PMID: 29185097 DOI: 10.1245/s10434-017-6196-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Indexed: 11/18/2022]
Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany.
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany
| | - Bs Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Dresden University of Technology, Dresden, Germany
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41
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Borkowetz A, Hadaschik B, Platzek I, Toma M, Torsev G, Renner T, Herout R, Baunacke M, Laniado M, Baretton G, Radtke JP, Kesch C, Hohenfellner M, Froehner M, Schlemmer HP, Wirth M, Zastrow S. Prospective comparison of transperineal magnetic resonance imaging/ultrasonography fusion biopsy and transrectal systematic biopsy in biopsy-naïve patients. BJU Int 2017; 121:53-60. [PMID: 28921850 DOI: 10.1111/bju.14017] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To evaluate the value of multiparametric magnetic resonance imaging (mpMRI) in the detection of significant prostate cancer (PCa) and to compare transperineal MRI/ultrasonography fusion biopsy (fusPbx) with conventional transrectal systematic biopsy (sysPbx) in biopsy-naïve patients. PATIENTS AND METHODS This multicentre, prospective trial investigated biopsy-naïve patients with suspicion of PCa undergoing transperineal fusPbx in combination with transrectal sysPbx (comPbx). The primary outcome was the detection of significant PCa, defined as Gleason pattern 4 or 5. We analysed the results after a study period of 2 years. RESULTS The study included 214 patients. The median (range) number of targeted and systematic cores was 6 (2-15) and 12 (6-18), respectively. The overall PCa detection rate of comPbx was 52%. FusPbx detected more PCa than sysPbx (47% vs 43%; P = 0.15). The detection rate of significant PCa was 38% for fusPbx and 35% for sysPbx (P = 0.296). The rate of missed significant PCa was 14% in fusPbx and 21% in sysPbx. ComPbx detected significantly more significant PCa than fusPbx and sysPbx alone (44% vs 38% vs 35%; P < 0.005). In patients presenting with Prostate Imaging Reporting and Data System (PI-RADS) 4 and 5 lesions there was a higher detection rate of significant PCa than in patients presenting with PI-RADS ≤3 lesions in comPbx (61% vs 14%; P < 0.005). CONCLUSIONS For biopsy-naïve men with tumour-suspicious lesions in mpMRI, the combined approach outperformed both fusPbx and sysPbx in the detection of overall PCa and significant PCa. Thus, biopsy-naïve patients may benefit from sysPbx in combination with mpMRI targeted fusPbx.
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Affiliation(s)
| | - Boris Hadaschik
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany.,Department of Urology, University Hospital Essen, Essen, Germany
| | - Ivan Platzek
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Marieta Toma
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Georgi Torsev
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Theresa Renner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Roman Herout
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Martin Baunacke
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Michael Laniado
- Department of Radiology and Interventional Radiology, Technische Universität Dresden, Dresden, Germany
| | - Gustavo Baretton
- Department of Pathology, Technische Universität Dresden, Dresden, Germany
| | - Jan Philipp Radtke
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | - Claudia Kesch
- Department of Urology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Michael Froehner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | | | - Manfred Wirth
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Stefan Zastrow
- Department of Urology, Technische Universität Dresden, Dresden, Germany
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42
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Vetterlein MW, Meyer CP, Leyh-Bannurah SR, Mayr R, Gierth M, Fritsche HM, Burger M, Keck B, Wullich B, Martini T, Bolenz C, Pycha A, Hanske J, Roghmann F, Noldus J, Bastian PJ, Gilfrich C, May M, Rink M, Chun FKH, Dahlem R, Fisch M, Aziz A, Bartsch G, Brookman-May S, Buchner A, Durschnabel M, Ellinger J, Froehner M, Georgieva G, Gördük M, Grimm MO, Hadaschik B, Haferkamp A, Hakenberg OW, Hartmann F, Herrmann E, Hertle L, Hohenfellner M, Janetschek G, Kraischits N, Krausse A, Lusuardi L, Michel MS, Moritz R, Müller SC, Novotny V, Nuhn P, Pahernik S, Palisaar RJ, Ponholzer A, Protzel C, Roigas J, Schmid M, Schramek P, Seitz C, Sikic D, Stief CG, Syring I, Vallo S, Wagenlehner FM, Weidner W, Wirth MP. Effect of Hospital and Surgeon Case Volume on Perioperative Quality of Care and Short-term Outcomes After Radical Cystectomy for Muscle-invasive Bladder Cancer: Results From a European Tertiary Care Center Cohort. Clin Genitourin Cancer 2017; 15:e809-e817. [DOI: 10.1016/j.clgc.2017.04.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 04/05/2017] [Accepted: 04/14/2017] [Indexed: 02/06/2023]
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43
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Borkowetz A, Platzek I, Toma M, Renner T, Herout R, Baunacke M, Laniado M, Baretton GB, Froehner M, Zastrow S, Wirth MP. Evaluation of Prostate Imaging Reporting and Data System Classification in the Prediction of Tumor Aggressiveness in Targeted Magnetic Resonance Imaging/Ultrasound-Fusion Biopsy. Urol Int 2017; 99:177-185. [DOI: 10.1159/000477263] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/03/2017] [Indexed: 11/19/2022]
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44
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Froehner M, Schaab F, Hofmockel T, Hoffmann RT, Fahlenkamp D, Wirth MP. Delayed Radiographic Manifestation of Renal Pseudoaneurysms After Blunt Trauma. Urology 2017; 103:e9-e10. [DOI: 10.1016/j.urology.2017.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 01/28/2017] [Accepted: 02/09/2017] [Indexed: 10/20/2022]
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45
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Walliczek-Dworschak U, Gudziol V, Mitzschke C, Froehner M, Hummel T. Testicular cancer patients undergoing cisplatin based chemotherapy exhibit temporary olfactory threshold scores changes. Eur Arch Otorhinolaryngol 2017; 274:2813-2818. [PMID: 28429112 DOI: 10.1007/s00405-017-4559-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/30/2017] [Indexed: 12/20/2022]
Abstract
Testicular cancer is the most frequent malignant disease in young males between 15 and 35 years. Platinum based chemotherapy regimen is the therapy of choice in advanced disease. This treatment has also adverse effects caused by the cytostatic active substances, such as olfactory dysfunctions. The aim of this study was, therefore, to monitor olfactory function of testicular cancer patients during and 6 months after chemotherapy. A total of 17 patients (mean age 31.06 ± 10.26 years), which underwent chemotherapy (mean 2.47 cycles ± 0.5) were enrolled in this study. Odor threshold, discrimination and identification were assessed by means of the "Sniffin' Sticks" prior to and on day 42, 90 and 180 after chemotherapy has been completed. Furthermore, patients' ratings of olfactory function and depressive symptoms were evaluated. Threshold scores were significantly lower on day 90 (8.0 ± 2.51) compared to baseline (10.4 ± 2.20) (p = 0.014) and recovered almost completely on day 180 (9.65 ± 3.26). Odor discrimination and identification did not show significant changes during therapy. The decrease of the olfactory function during/immediately after chemotherapy was underlined by the subjectively perceived impaired olfactory function during this time. In addition almost every fourth patient presented with a depressed mood at the beginning of chemotherapy. Patients should be informed about possible transient olfactory impairment during/immediately after chemotherapy.
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Affiliation(s)
- Ute Walliczek-Dworschak
- Department of Otorhinolaryngology, Smell and Taste Clinic, Interdisciplinary Center Smell and Taste, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. .,Department of Otorhinolaryngology, Philipps-University, Marburg, Germany.
| | - Volker Gudziol
- Department of Otorhinolaryngology, Smell and Taste Clinic, Interdisciplinary Center Smell and Taste, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Claudia Mitzschke
- Department of Otorhinolaryngology, Smell and Taste Clinic, Interdisciplinary Center Smell and Taste, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Michael Froehner
- Department of Urology, Technische Universität Dresden, Dresden, Germany
| | - Thomas Hummel
- Department of Otorhinolaryngology, Smell and Taste Clinic, Interdisciplinary Center Smell and Taste, Technische Universität Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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46
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Froehner M, Koch R, Hübler M, Heberling U, Novotny V, Zastrow S, Wirth MP. MP21-07 SELECTION EFFECTS MAY EXPLAIN SMOKING-RELATED OUTCOME DIFFERENCES AFTER RADICAL CYSTECTOMY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.3269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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47
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Borkowetz A, Platzek I, Toma M, Renner T, Baunacke M, Froehner M, Zastrow S, Wirth M. PD43-01 ASSESSMENT OF TUMOUR-AGGRESSIVENESS IN TRANSPERINEAL MRI/ULTRASOUND-FUSION BIOPSY IN COMPARISON TO TRANSRECTAL SYSTEMATIC PROSTATE BIOPSY IN PATIENTS WITH AND WITHOUT PRIOR BIOPSY. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.1906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Borkowetz A, Platzek I, Toma M, Renner T, Baunacke M, Froehner M, Zastrow S, Wirth M. MP18-02 EVALUATION OF MRI/ULTRASOUND-FUSION BIOPSY IN PATIENTS WITH LOW-RISK PROSTATE CANCER UNDER ACTIVE SURVEILLANCE. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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49
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Froehner M, Koch R, Hübler M, Zastrow S, Wirth MP. PD51-03 PREDICTING COMPETING MORTALITY IN PATIENTS UNDERGOING RADICAL PROSTATECTOMY AT AN AGE OF 70 YEARS OR OLDER. J Urol 2017. [DOI: 10.1016/j.juro.2017.02.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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50
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Froehner M, Koch R, Propping S, Liebeheim D, Hübler M, Baretton GB, Hakenberg OW, Wirth MP. Level of education and mortality after radical prostatectomy. Asian J Androl 2017; 19:173-177. [PMID: 28051039 PMCID: PMC5312214 DOI: 10.4103/1008-682x.178487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Estimating the risk of competing mortality is of importance in men with early prostate cancer to choose the most appropriate way of management and to avoid over- or under-treatment. In this study, we investigated the impact of the level of education in this context. The study sample consisted of 2630 patients with complete data on level of education (college, university degree, master craftsmen, comparable profession, or others), histopathological tumor stage (organ confined or extracapsular), lymph node status (negative or positive), and prostatectomy specimen Gleason score (<7, 7, or 8–10) who underwent radical prostatectomy between 1992 and 2007. Overall, prostate cancer-specific, competing, and second cancer-related mortalities were study endpoints. Cox proportional hazard models for competing risks were used to study combined effects of the variables on these endpoints. A higher level of education was independently associated with decreased overall mortality after radical prostatectomy (hazard ratio [HR]: 0.75, 95% confidence interval [95% CI]: 0.62–0.91, P = 0.0037). The mortality difference was attributable to decreased second cancer mortality (HR: 0.59, 95% CI: 0.40–0.85, P = 0.0052) and noncancer mortality (HR: 0.73, 95% CI: 0.55–0.98, P = 0.0345) but not to differences in prostate cancer-specific mortality (HR: 1.16, 95% CI: 0.79–1.69, P = 0.4536 in the full model). In conclusion, the level of education might serve as an independent prognostic parameter supplementary to age, comorbidity, and smoking status to estimate the risk of competing mortality and to choose optimal treatment for men with early prostate cancer who are candidates for radical prostatectomy.
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Affiliation(s)
- Michael Froehner
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Rainer Koch
- Department of Medical Statistics and Biometry, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Stefan Propping
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Dorothea Liebeheim
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Matthias Hübler
- Department of Anesthesiology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Gustavo B Baretton
- Department of Pathology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
| | - Oliver W Hakenberg
- Department of Urology, University of Rostock, Ernst-Heydemann-Strasse 6, D-18055 Rostock, Germany
| | - Manfred P Wirth
- Department of Urology, University Hospital "Carl Gustav Carus", Technische Universität Dresden, Fetscherstrasse 74, D-01307 Dresden, Germany
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